Kristine N. Williams

Elderspeak Communication: Impact on Dementia Care

Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.

Exploring Interventions to Reduce Cognitive Decline in Aging

As the population ages, risks for cognitive decline threaten independence and quality of life for older adults and present challenges to the health care system. Nurses are in a unique position to advise older adults about cognitive health promotion and to develop interventions that optimize cognition in older adults. A literature review was conducted to provide nurses in mental health and geriatric care with an overview of research related to the promotion of successful cognitive aging for older adults. Research evaluating cognitively stimulating lifestyles and the effects on cognitive function in older adults of interventions targeting cognitive training, physical activity, social engagement, and nutrition were reviewed. Overall research findings support positive effects of cognitive and physical activity, social engagement, and therapeutic nutrition in optimizing cognitive aging. However, the strength of the evidence is limited by research designs. Applications for health promotion to optimize cognitive aging and future directions for research are discussed.

Implications of differential impacts of care-giving for future research on Alzheimer care

As the primary caregivers for the millions afflicted with Alzheimers disease, family members have been the focus of research for the past two decades. Differences in care patterns and deleterious effects of care provision have been clearly established. However, similar demands and hardships associated with care-giving result in different consequences for different families. A greater understanding of the care-giving context and its determinants will enhance knowledge of the differential impacts of care-giving. The most critical determinant of care-giving context is the role relationship between the caregiver and the care recipient. Future research must address role relationship as the primary determinant of what care is provided by whom , and in what manner . This will enhance the understanding of specific caregiver outcomes and lead to optimal targeting of interventions. Future research must also focus on the interface between the family and other social institutions. Evidence calls into question the equity, quality, and capacity of the current system of care, which assumes that family care is best. It will be important for future studies to explore alternate options for long-term care policy. Families and patients will also benefit from studies that assess strategies to ensure an adequate labor pool of qualified formal caregivers.

Enhancing Communication With Older Adults: Overcoming Elderspeak

Because communication behaviors are difficult to change, practicing speech without elderspeak is helpful in preparing for actual clinical situations. The Communication Enhancement Model describes potential benefits of eliminating elderspeak in speech to older adults. Minimizing the use of elderspeak is hypothesized to reduce stereotype-based messages that older adults are incompetent and dependent. An improved communication environment promotes the cognitive and functional abilities of older adults. Achieving optimal communication environments may contribute to higher levels of well-being for older adults and to increased quality of life. Young adult care providers also may benefit from increased job satisfaction if they relate closely with care recipients.

Elderspeak’s Influence on Resistiveness to Care: Focus on Behavioral Events:

Resistiveness to care (RTC) in older adults with dementia commonly disrupts nursing care. Research has found that elderspeak (infantilizing communication) use by nursing home (NH) staff increases the probability of RTC in older adults with dementia. The current analysis used general sequential querier (GSEQ) software to analyze behavior sequences of specific behavioral events. We found that older adults with dementia most frequently reacted to elderspeak communication by negative vocalizations (screaming or yelling, negative verbalizations, crying). Because negative vocalizations disrupt nursing care, reduction in elderspeak use by staff may reduce these behaviors thereby increasing the quality of care to these residents. The results clearly demonstrate that sequential analysis of behavioral events is a useful tool in examining complex communicative interactions and targeting specific problem behaviors.

Linking Resident Behavior to Dementia Care Communication: Effects of Emotional Tone

Care for older adults with dementia is complicated by behaviors such as verbal and physical aggression and withdrawal that disrupt and increase the costs of providing care. These behaviors, referred to as resistiveness to care (RTC), have been linked to staff elderspeak communication, measured by behaviorally coded explicit behaviors. This study examined videotapes of nursing home (NH) residents with dementia interacting with staff during bathing to explore the relationships between implicit messages communicated by nursing staff and resident RTC behavior. Implicit messages in nursing staff communication were rated using the Emotional Tone Rating Scale by naïve coders. Associations between implicit ratings of care, respect, and control were analyzed in relation to RTC scale scores. Highly controlling communication was significantly correlated with increased resident RTC (r=.49, p<.05). Associations between the care and respect dimensions of communication were not significantly correlated with RTC; however, trends in hypothesized directions were identified. The association between emotional tone and RTC found in this study suggests that it is an important factor in care. Understanding affective messages is a first step in modifying these implicit messages conveyed during staff-resident communication. Research is needed to confirm these findings and to identify and test interventions to teach staff to reduce controlling messages that will to reduce RTC and improve care.

In-Home Monitoring Support for Dementia Caregivers: A Feasibility Study

Technology provides new opportunities for interventions to improve quality and access to health care. This study evaluated a telehealth application to support family dementia caregivers providing homecare. We explored feasibility of in-home video monitoring and feedback to help caregivers and reduce caregiving burden. A caregiver-patient dyad was recruited from a Midwestern University Alzheimer’s Disease Center. The caregiver triggered video recordings on a laptop computer using a remote control that also recorded 5 min prior to pressing “record.” Recordings were automatically uploaded via the Internet for interdisciplinary team review and feedback. Issues related to Internet transfer and storage of health information and computer security were addressed. Professionals reported the value of video recordings for identifying antecedents and evaluating caregiver responses. The caregiver reported improved communication and behavior management and ease of use. This study developed protocols, processes, and contractual arrangements and established the feasibility and benefits of home monitoring as a basis for ongoing research.

Enhancing communication with older adults: Overcoming elderspeak

Gerontological nurses promote health and successful aging for a growing population of older adults. Care providers unknowingly may communicate messages of dependence, incompetence, and control to older adults by using elderspeak, a speech style similar to baby talk, that fails to communicate appropriate respect. This article describes a communication training program that significantly reduced the use of elderspeak by nursing assistants and led t more respectful, less controlling, and equally as caring communication between nursing assistants and nursing home residents. Strategies to use in evaluating and enhancing interpersonal communication with older clients are provided. Therapeutic communication is a critical tool for nurses who provide health care to the growing populati of older adults.

Visual Cues for Person-centered Communication:

Nursing home communication is frequently limited and task-focused and fails to affirm resident personhood. We tested the feasibility and effects of automated digital displays of resident photographs to remind staff (N = 11) of resident (n = 6) personhood. Historical photographs were displayed in digital photo frames mounted in each resident’s room. To evaluate the intervention’s effects, staff–resident conversations were audio-recorded prior to displaying the frames and repeated 2 weeks and 3 months later. Conversations were transcribed and statements were topic coded (task-focused vs. interpersonal). Staff person-centered talk increased from 11% to 32% (z = 2.37, p = .02) after the intervention and task-talk decreased from 64% to 40%. Resident interpersonal topics increased from 20% to 37%. Staff statements increased from 29 at baseline, to 37 postintervention, and 41 at 3-month follow-up and resident engagement and reminiscence also increased. Effects were reduced after 3 months. Automated photo displays are an easily implemented, low-cost intervention to promote person-centered communication.

Psychometric Analysis of the Emotional Tone Rating Scale: A Measure of Person-Centered Communication.

Psychometric analysis of the Emotional Tone Rating Scale (ETRS) was completed using ratings of naïve listeners who evaluated staff-resident communication in three nursing homes. Interrater consistency was high with ICC (2, 1) for agreement = .95 and consistency = .95. Factor analysis revealed two factors—person-centered communication and controlling communication—that explained 84.8% of the variance. Person-centered communication included seven descriptors (items) with loadings ranging from .84 to .98 and a coefficient alpha of .98. Controlling communication included five items that loaded from –.63 to .99 with a coefficient alpha of .94. These factors were negatively correlated (p = –.64) and demonstrated good ranges, standard deviations, and high item-total correlations. Person-centered communication correlated with higher resident engagement in conversation in contrast to controlling communication. The ETRS provides a measure of person-centered communication that can be used to evaluate interactions between nursing staff and older adults who reside in long term care settings.